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Germany

D. Independent living

D1. Choice of living arrangements

The disability rights movement has successfully establish the concept of personal assistance (the so called 'employer model') as well as an infrastructure to support independent living. At local level there are around 20 centres run by disabled people which offer counselling and practical support for all disabled people who want to live independently. There are also several national (umbrella) organisations which provide networks and also lobby on the issues. In recent years, some positive developments towards implementation of the approach of independent living takes place. The Disability Equality Act of 2002 (Gesetz zur Gleichstellung behinderter Menschen – Behindertengleichstellungsgesetz, BGG) has brought the issue of accessibility to the fore.

The Federal Participation Law (Bundesteilhabegesetz) from 2016 promotes free choice of living arrangements and the transition from institutional care to private households. At the same time some regulations weaken this principle. The so called ‘higher cost reservation’ (Mehrkostenvorbehalt) determines that people with disabilities can be forced to live in residential homes and/or forced to pool benefits/assistance if private and individual solutions are more expensive and/or considered unreasonable (Deutsches Institut für Menschenrechte 2015). Thus, the choice of independent living arrangements can be limited again.

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Update date: Tue, 2019-05-14

D2. De-institutionalisation

The social assistance system (Social Code Book XII) and, as part of it, the 'Integration Support for Disabled People' [Eingliederungshilfe für behinderte Menschen; section 53 ff. SGB XII] as well as the Long Term Care Insurance (Social Code Book XI) are based on the principle of community oriented assistance and care. This priority is not valid if its execution would result in disproportionally extra costs in comparison with institutional support (section 13 paragraph 1 SGB XII). But the term 'disproportionally extra costs' is not regulated and exact sums are not numbered. The decision is taken by the responsible administration which considers the individual case in question and the social budget of the respective region. Officially disabled people have the right to choose between different types of institutional and home care opportunities. In 2008 the law for the further development of the mandatory long term care insurance [Gesetz zur strukturellen Weiterentwicklung der Pflegeversicherung] reformed the long-term care insurance system in many aspects: the existing lump sums for institutional and home care were increased; care benefits for people with cognitive disabilities and dementia were upgraded. Individual case management and the option of care assistance for people with comprehensive support needs in areas of daily living were introduced. Another law [Gesetz zur Regelung des Assistenzpflegebedarfs im Krankenhaus] stipulated that disabled people who rely on personal assistance are entitled to keep their personal assistants during their stay in hospital.

As a consequence, the Federal Participation Law (Bundesteilhabegesetz) from 2016, on the one hand, promotes deinstitutionalisation through free choice of living arrangements and the transition from institutional care to private households. On the other hand, some regulations (such as the ‘higher cost reservation’ (Mehrkostenvorbehalt)) can force people with disabilities into residential homes if private and individual solutions are more expensive than institutional ones (Deutsches Institut für Menschenrechte 2016).

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Update date: Tue, 2019-05-14

D3. Quality of social services

In 2008, the German system of long-term care insurance was reformed in order to provide better quality management: services such as counselling and support for caregivers as well as the evaluation and regular control procedures of long-term care institutions were improved; individual case management was introduced. In 2012/2013 the long-term care readjustment law [Pflege-Neuausrichtungs-Gesetz, PNG] came into force. It increased the benefits for old people with dementia and their families, made care services and benefits more flexible and introduced supplementary private long-term care insurance.

Since January 2017 changes have been made to nursing care insurance. The different levels of care (Pflegestufen) have been transformed into degrees of care (Pflegestufen). Along with the implementation of degrees of care, the classification of nursing care has been based on a person’s autonomy in certain areas of life. As the grandfathering clause is indefinite, it is impossible to downgrade previously granted care services. By now, it is not clear and has not been evaluated whether the changes in nursing care will lead to improvements or not.

In February 2019 the Commissioner of People with Disabilities pointed out at a conference in Düsseldorf, that the health care system has to be more inclusive-oriented and more oriented on the needs and wishes of disabled people. He stipulates a better situation for this kind of group.

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Update date: Tue, 2019-05-14

D4. Provision of assistive devices at home

In Germany assistive devices at home are mainly financed through health insurance or, if a device is needed in the case of long-term care, the long term care insurance applies. If a disability is due to an accident, the accident insurance is responsible for financing necessary equipment.

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Update date: Tue, 2019-05-14

D5. Availability of personal assistance schemes

In Germany personal assistance services for independent living that are controlled and directed by disabled people themselves have been gradually developed and established since the 1980s. In principle, today all persons with severe disabilities and in need of comprehensive assistance are entitled to personal assistance. Personal assistance is financed through the 'Integration Support for Disabled People' [Eingliederungshilfe für behinderte Menschen; Section 53 ff. SGB XII] as part of the social assistance law regulated in the Social Code Book XII [Sozialgesetzbuch XII]. The introduction of the mandatory long-term care insurance in 1995 [Sozialgesetzbuch XI] has been regarded by independent living activists as a backlash, as it draws on a medical and reductionist model of long-term care. It is worth noting however that even this scheme aims, at least in principle, at community orientation and individual self-determination. Direct payments have been gradually introduced since the Social Code Book for Rehabilitation and Participation of Disabled People [Sozialgesetzbuch IX], as a framework act, came into force in 2001; taking the form of personal budgets, they have become a legal right since 2008. The introduction of personal budgets will further promote the implementation of independent living.

The ‘personal budgets’ have the potential to promote the implementation of independent living, as lump sums are granted, distributed and managed according to individual needs and life situations. There are three ways to organize and manage work assistance: a) self-reliant, b) as service model (specific services provide assistance services), c) as a mixture of a) and b). The funding can also be provided by a personal budget according to § 17 of the Social Code Book IX (SGB IX) or as a benefit in kind trough a relevant service provider (betanet 6). However, the use of such services requires a lot of effort due to bureaucratic constraints.

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Update date: Tue, 2019-05-14

D6. Income maintenance

In general, the German social security system offers several types of income maintenance for disabled people: old age pensions, pensions depending on the individual degree of work capacity, basic income for disabled people under the poverty line, and basic income for unemployed people with disabilities.
Firstly, as the majority of people with official disability status in Germany have reached retirement age and are no longer in employment, main source of income for disabled people is pensions. Secondly, there are additional types of pensions for disabled individuals with no, or reduced work capacity that depend on the individual degree of work capacity; one can either receive a pension due to full reduction in earning capacity [Rente wegen voller Erwerbsminderung] or a pension due to partial reduction in earning capacity [Rente wegen teilweiser Erwerbsminderung]. Recipients of the pension due to full reduction in earning capacity are obliged to have 'an earning capacity' which is less than three hours per day. Whereas recipients of the pension due to partial reduction of earning capacity are regarded as capable of working for three to six hours per day. Thirdly, supplementary to the pension insurance system, there is a social security benefit that offers basic income for two groups. The first group is formed by people who receive regular pensions or other financial benefits which are under the poverty line. The second group includes disabled people who have never been, and are not likely to become members of the workforce. Usually this group cannot get regular employment, but works in sheltered workshops. The so-called basic pension for old age pensioners under the poverty line as well as persons with no earning capacity [Grundsicherung im Alter und bei Erwerbsminderung] entered into force in 2003 and is granted either to people over 65 resp. 67 in order to prevent poverty or to disabled persons aged 18-64 who have a constant reduction of earning capacity. Fourthly, if disabled people are part of the workforce, are able to work and have not yet reached retirement age, but become unemployed, they are entitled to receive the unemployment benefit [Arbeitslosengeld] as part of the law to promote employment and to protect against unemployment (Social Code Book III) for the maximum period of one year. After this period, they are entitled to a lower social benefit which is called 'basic income for job applicants' and administered according to the principles of subsidiarity and poverty relief (Social Code Book II). In 2014 the non-contributory supplementary period [Zurechnungszeit] of the pension due to no or reduced earning capacity [Erwerbsminderungsrente] has been expanded for two years (from 60 to 62 years). This change in calculation has resulted in higher pension payments.

Currently, the reform of the Participation Act (Bundes - Teilhabegesetz, BTHG) is underway. This means that the individual case support will be removed from the Social help and included into the SGB IX up until 1 January 2020. Accordingly, the income and property situation of people with disability will be optimised. Until the end of 2019 a temporary solution will be provided.

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Update date: Tue, 2019-05-14

D7. Additional costs

In Germany there are different types of financial benefits for disabled people. The mandatory long-term care insurance offers lump sums [Pflegegeld] depending on the three official levels of care needs. The person in need of and entitled to care can choose these lump sums instead of professional services; with this money the individual can pay family members, friends, neighbours or other persons for providing personal care and support (section 37 SGB XI). The integration support for disabled people [Eingliederungshilfe für behinderte Menschen; see section 53 ff. SGB XII] as part of social assistance law regulated in Social Code Book XII [Sozialgesetzbuch XII] provides, in comparison to standard social assistance, generous income limits and less restrictive means testing for disabled recipients and their families. Blind and deaf persons are entitled to a monthly sum without means testing [Blindengeld; Hilfe für Gehörlose] on the basis of the Assistance for Blind and Deaf Persons Law [Gesetz über die Hilfen für Blinde und Gehörlose]. Thalidomide victims receive pensions monthly without means testing on the basis of the law that regulates the compensation claims due to Thalidomide and provides support for this group of disabled people [section 13 Gesetz über die Conterganstiftung für behinderte Menschen]. Last but not least, the Federal Child Support Law (section 2 Bundeskindergeldgesetz) stipulates that in the case of a disabled child who is not able to support him/herself, the monthly child benefit [Kindergeld] will be paid beyond the standard age limit of 25 years.

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Update date: Tue, 2019-05-14

D8. Retirement income

Disabled people who have been part of the workforce are entitled to receive benefits from the mandatory Old Age Pension Insurance after retirement. Additionally they may receive payments from private insurances. Supplementary to the pension insurance system, there is a social security benefit [SGB XII: Grundsicherung im Alter und bei Erwerbsminderung] which offers basic income for two groups. The first group is formed by people who receive regular pensions or other financial benefits which are under the poverty line. The second group includes people who have never been and are not likely to become members of the workforce; usually this group cannot get regular employment, but works in sheltered workshops. The so-called basic pension for old age pensioners under the poverty line as well as persons with no earning capacity [Grundsicherung im Alter und bei Erwerbsminderung] entered into force in 2003 and is granted either to people over 65 in order to prevent poverty or to persons aged 18-64 who have a constant reduction of earning capacity. A person who has worked in a sheltered workshop for at least 20 years may receive a pension equivalent to other old age pensions, but the benefits are earning-related and will usually be rather low in the case of workshop employment. If monthly pensions are under the poverty line, recipients may receive a supplementary basic income.

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Update date: Tue, 2019-05-14

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